EUS-Guided Broad Plexus Neurolysis Over the Superior Mesenteric Artery Using a 25-Gauge Needle
EUS-Guided Broad Plexus Neurolysis Over the Superior Mesenteric Artery Using a 25-Gauge Needle
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DOI：
10.1038/ajg.2010.339
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发表时间：
2010-12-01
影响因子：
9.8
通讯作者：
Kudo, Masatoshi
中科院分区：
文献类型：
--
作者：
Sakamoto, Hiroki;Kitano, Masayuki;Kudo, Masatoshi
目的：超声内窥镜(EUS)引导下腹腔神经丛松解术(EUS-CPN)安全有效，但对部分扩大腹癌患者不利。我们比较了标准EUS-CPN和EUS引导下的宽丛神经松解术(EUS-BPN)的疗效，EUS-BPN使用25号针穿过肠系膜上动脉(SMA)。为了评价神经松解的扩散，将造影剂与神经松解剂混合，并在术后进行CT扫描。腹膜动脉、肠系膜上动脉和肠系膜下动脉的区域在额面上分为6个区域：右上和左上、右中和左中、右下和左下。EUS-CPN和EUS-BPN术后的造影区数目与疼痛缓解程度有关。结果：共纳入67例晚期腹癌患者，其中EUS-CPN 34例，EUS-BPN 33例。两组的定性变量无显著差异。EUS-BPN组有6个造影区的患者(42%)多于EUS-CPN组(0%)。这些患者的短期和长期疼痛缓解效果明显好于少于五个对比度区域的患者。在第7天和第30天，EUS-BPN患者的视觉模拟疼痛评分较EUS-CPN患者显著降低。结论：我们的初步数据显示，使用25号针的EUS-BPN为晚期腹癌患者提供了比标准EUS-CPN更好的止痛效果，并且没有发生严重的并发症。此外，对SMA进行广泛的神经松解似乎可以提供更好的止痛效果。
OBJECTIVES: Endoscopic ultrasonography (EUS)-guided celiac plexus neurolysis (EUS-CPN) is safe and effective but not beneficial for some patients with extended abdominal cancer. We compared the effectiveness of standard EUS-CPN and EUS-guided broad plexus neurolysis (EUS-BPN) that extends over the superior mesenteric artery (SMA) using a 25-gauge needle.METHODS: Consecutive patients referred to our quaternary EUS centers were eligible for inclusion. To evaluate the neurolytic spread, contrast was mixed with the neurolytic agent and post-procedure computed tomography scanning was performed. The regions containing the celiac, superior, and inferior mesenteric arteries were divided on the frontal plane into six areas: upper right and left, middle right and left, and lower right and left. The number of contrast-bearing areas after EUS-CPN and EUS-BPN were related to the degree of pain relief achieved.RESULTS: A total of 67 patients with advanced abdominal cancer were included (34 EUS-CPN and 33 EUS-BPN). The qualitative variables of the two groups did not differ significantly. The EUS-BPN group had more patients with six contrast-bearing areas (42%) than the EUS-CPN group (0%). These patients had significantly better short-term and long-lasting pain relief than patients with less than five contrast-bearing areas. EUS-BPN patients exhibited significantly greater reductions in days 7 and 30 visual analog pain scale scores than EUS-CPN patients.CONCLUSIONS: Our preliminary data suggested that EUS-BPN using a 25-gauge needle provides patients with advanced abdominal cancer with better pain relief than standard EUS-CPN, and without incurring serious complications. Moreover, it seems that broad neurolysis over the SMA may provide superior analgesia.